The Connected Healthcare Community:

A New Model for Healthcare in the U.S.

NextGen Financial Stability and Scale True Enterprise Architecture (web access to EHR) Single Database Integration Deep Multi-Specialty Support Community Health Solution (CHS) Patient Communication (NextMD) Powerful P4P and disease management

reporting capabilities Market Deployment Assistance (RAMP)

Why NextGen for Health Systems:

Presentation Content

• NextGen Corporate Overview

• Health System EHR & Stark Strategies

• NextGen Health System Solutions

• Community Health Solution (CHS)

• NextMD

• RAMP

A wholly owned subsidiary of Quality Systems, Inc.

Manufactures electronic medical records and practice management systems for the ambulatory market space

Founded in 1994 as Clinitec International

Headquarters in Horsham, PA and Atlanta, GA

600+ Employees

2,000 practices, 30,000 Providers

About NextGen Healthcare

NextGen EMR EPM

ICS

CHS

NextMD

The NextGen Product Suite

FY 2007 revenues $157 Million

No Debt

Publicly traded (NASDAQ: QSII)

Cash reserves now over $70 M

#4, Forbes Best 200 Small Companies

Market cap of $880M

Financial Facts

Gartner Magic Quadrant

NextGen in “Leaders” quadrant

Innovation Award: Disease Surveillance, MS-HUG Award Partner: Joslin Clinic

Innovation Finalist: Ambulatory EHR, MS-HUG Award Partner: Crystal Run Healthcare

#1 Functionality Rating, AC Group Top ranking in multi-specialty, community health records, FQHC, large, mid-size, and small practices categories

Innovation Finalist: Ambulatory EHR, MS-HUG Award Partner: Crystal Run Healthcare

2007 Awards

Innovation Award: Disease Surveillance, MS-HUG Award Partner: Medical College of Wisconsin

2008 Awards

Health System EHR and Stark Strategies

Improved quality of care and patient safety via information sharing

Enhanced Referral Management Networks

Improved patient and community relations

Clinically integrated virtual staff models

Health System Integration – Driving Forces

Offerings must be focused on sharing of patient clinical information

Must be able to demonstrate interoperability (w/hospital and other medical systems)

Physician participation cannot be determined by volume or value of referrals

Recipients must contribute 15% of cost

Must have eRx capabilities

Subject to written agreement

Safe Harbor to Stark Regulations

Integrated Medical Staff Models

owned

independent medical staff

referring community

MSO

PHO or IPA

Virtual Clinical Integration

owned

independent medical staff

referring community

MSO

PHO or IPA

Data display

Data retrieval

Workflow

Decision Support

Predictive Models

Clinical Integration Strategies

Web-based EHR/Interoperability

Data Access

Web Portal

Auto-route and print to office

$30-50

Data Retrieval

View results

Messaging & Alerts

Download or Synch Data

$50-70

Work Flow

Intelligent Messaging

ePrescribing

Lab Order Entry

$60-100

Decision Support

Community Hub

EHR Interfaces

Charge capture

Health Maint.

Referral Management

$400-500

Integrated EHR

Seamless EHR

Longitudinal History

Disease Management

Advanced Analytics

$600-1000

EHR Endorsement/Negotiated Pricing

Hospital/EHR/EPM integration services

Health System Sponsored ‘Health Information Exchange’

Managed Service Offering EHR/EPM (financing/ASP)

Subsidized EHR funding up to 85%

EHR Distribution Strategies

EMR licenses and maintenance

HW & Network Infrastructure

Interoperability standards enforcement (EMPI, Lab coding, etc…)

Data exchange agreements

Interface/Integration & PMS support

Physician office physical environment

Deployment/Training responsibility

On-going Help-Desk support

EHR Strategy Considerations

• Patient-centric design

• Disparate IT systems unified through a shared architecture

• Collaborative Care Model

• All providers have access to complete, up-to-date information

Physicians & Staff

Hospitals

Diagnostic Labs

Patients

Managed Care

Community Health Information Exchange

Pharmacies

COST CATEGORIES Pass Thru Model Financed Model Subsidy Model

Year 1 Year 2 Year 3 Year 1 Year 2 Year 3 Year 1 Year 2 Year 3

Physician One Time Costs $ 38,000 $ - $ - $ 8,000 $ - $ - $ 8,000 $ - $ -

Physician Monthly Costs

ASP Hosting $ 350 $ 350 $ 350 $ 350 $ 350 $ 350 $ 100 $ 100 $ 100

Software $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 85 $ 85 $ 85

Front-end Cost Recap $ - $ - $ - $ 470 $ 470 $ 470 $ 70 $ 70 $ 70

Clearinghouse Fees $ 100 $ 100 $ 100 $ 100 $ 100 $ 100 $ 100 $ 100 $ 100

Sub w/o Connectivity $ 700 $ 700 $ 700 $ 1,170 $ 1,170 $ 1,170 $ 355 $ 355 $ 355

Connectivity $ 550 $ 550 $ 550 $ 550 $ 550 $ 550 $ 110 $ 110 $ 110

Per Physician Monthly Cost $ 1,250 $ 1,250 $ 1,250 $ 1,720 $ 1,720 $ 1,720 $ 465 $ 465 $ 465

Total Cost Per Year

Hosptial Up Front Cost $ - $ - $ - $ 29,000 $ - $ - $ 29,000 $ - $ -

Hospital Subsidy $ - $ - $ - $ - $ - $ - $ 12,043 $ 12,043 $ 12,043

Physician Subsidy Models

NextGen Health System Solutions

True Enterprise Architecture (web access to EHR) Single Database Integration Multi-Specialty Support Community Health Solution (CHS) Patient Communication (NextMD) Powerful P4P and disease management

reporting capabilities Market Deployment Assistance (RAMP)

Why NextGen for Health Systems:

Single NextGen Database

Fully Integrated Solutions

Enterprise Architecture

Single Database

Multiple Entities

Associations Enterprise

Location

Roles

Users

Sharing information Demographics, Meds, Allergies,

Diagnosis, Procedures

Maintaining Privacy

Enterprise Architecture

Cardiology

Ophthalmology

Orthopedics

OB/GYN

Primary Care/Family Practice

Community Health Centers

Rheumatology

Pediatrics

Otolaryngology

Dermatology

Urology

Multi-Specialty Clinics

Specialty Content

The goals of CCHIT product certification are to:

• Reduce the risk of HIT investment

• Ensure interoperability (compatibility) of HIT products

“Software will be deemed to be interoperable if a certifying body recognized by the Secretary (CCHIT) has certified the software within no more than twelve (12) months prior to the date it is provided to the recipient.“

CCHIT is the recognized certification authority for EHRs

Community Health Solution

• Holy Grail of EHRs

– continuous flow of structured data

– full data integration

• Shared Medical Record for an Entire Community

Community Health Solution

Longitudinal access to clinical data

Security Infrastructure and Model

Master Person Resolution

Data Integration

Codification Libraries

Workflow Engine

Reporting Infrastructure

Web Application Delivery

CHS Interoperability Platform

Web Users

Seamless Integration to Repository Data

Inter/Cross Enterprise Referrals

Automated Data Notifications

Automated Upload of Core Data

Filter Capability on Data Imports

HL7 Data (Documents and

Demographics)

HL7

Feeds

NextGen EMR Users – Enterprise DB 1

Hospitals

NextGen EMR Users – Enterprise DB 2

Demographics and Documents

Routed via CHS to

Multiple NextGen EMR’s

Pass Through Lab Orders from Multiple EMR

Enterprises

Results Only Interface to distribute Lab Data

Standard User

Emergency

Room/Provider View

Access to

Patient Centric Chart

for

Medications

Allergies

Diagnosis

Documents

Referral View

Labs

Images

Full Web User

Data Entry Capability

for

Add/Modify/Delete

Patient

Problems (ICD9,DSM4)

Immunizations

Allergies

Lab Result Receipt and

Signoff

Referral Entry /

Management

CCR/CCD Payload

3rd Party EMR’s

XDS Query, Retrieval Mechanisms

XDS Submission Mechanism

CHS Release 7

Health System Configuration

CHS Release 7

NextGen CHS markets

Live site

Implementation Planning

Ann Arbor, MI

Doylestown, PA

Shares data & messaging between multiple NextGen and 3rd Party EMR users

Community-wide Portal Applications:

Patient Demographic Search & Clinical History

Prescription Management Referral Tracking

Lab/Radiology Ordering & Results

Analytics Reporting & Dashboard

CHS Functionality

Benefit Why?

Closer affiliation with hospital Physicians know who is brokering the exchange

Quality Reduced Errors

More complete record

Break the glass

The record is more easily shared and more complete doctors have the info they need for a more informed, higher-quality visit

Increased utilization Admissions, Ancillary Services

Technology makes it faster and easier to refer to the hospital so utilization goes up

Reduced Costs A more complete chart eliminates unnecessary re-orders of tests

Patient Satisfaction Shared patient data eliminates re-work by the patient

Reduced IT Expense IT can eliminate the need for multiple interfaces

Lock-in Once involved, walking away from referrals, results & patients is hard

Physician Relations Value Proposition

CHS gives their Relations staff a new reason to visit

Pharmacy/eRx Labs Radiology

•Payors Clearinghouse •PBM / RxHub

Kittitas Valley

Hospital • Emergency Room • Remote Consultants • Practices with no EMR

NextGen EPM/EMR

• Valley Clinic • Ellensburg Fam. Pr • Hospital Practices

McKesson Paragon

NextGen CHS NextGen Enterprise •SureScripts

•Fletcher Flora •PAML NextGen RTS

• ViaTrak • RxHub

NextMD patient portal

Kittitas Valley, Washington Tomorrow’s CCHIT Architecture Today

Orion Rhapsody

NextMD

Features:

Patient Messaging

Prescription Renewals

Appointment Scheduling

Attachments and Interactive Medical Forms

Patient Education

Patient Statements

Seamless Integration to EHR/EPM

CHS Referral Network

Payers

Primary Care

Hospital, Specialists

Regional Affiliate Marketing Program

• Co-marketing plan customized for hospitals to affiliates

Branding, seminars, PR, messaging, etc.

• Offers EMR/EPM/CHS to non-owned practices

Special pricing and packages

• Creates a community data exchange infrastructure

Complete patient records and workflow automation

• Excellent Stark opportunity

Regional Affiliate Marketing Program

• Improved ambulatory physician affinity

• Rapid and efficient deployment of EMRs

• Outsourced management of connectivity, interfaces

• Access to ambulatory patient data for:

Emergent care or care continuity

Patient safety, medication reconciliation

Clinical trials, outcomes reporting, P4P, etc…

Administration savings

Benefits

Regional Affiliate Marketing Program

Why It Works

• Connectivity through NextGen CHS

• Leading ambulatory EMR, with:

Clinical content for 26 specialties

Discrete data captured for exchange and mining

Data exchange industry standards incorporated

2007 CCHIT certification, critical for Stark

• Full “community” suite of integrated products

• Hospital endorsement and contacts

Regional Affiliate Marketing Program

What It Entails

• Product brochure and pricing guide

• Large or small-scale symposia

• PR, telemarketing, direct mail, e-mail, ads

• Custom website

• Educational resources and tools

Regional Affiliate Marketing Program

How It Works

• Leverages NextGen marketing resources and experience

• Materials, messages already developed

• Replicates successful programs

Regional Affiliate Marketing Program

NextGen Financial Stability and Scale True Enterprise Architecture (web access to EHR) Single Database Integration Deep Multi-Specialty Support Community Health Solution (CHS) Patient Communication (NextMD) Powerful P4P and disease management

reporting capabilities Market Deployment Assistance (RAMP)

Why NextGen for Health Systems:

Additional Slides

Regional Affiliate Marketing Program (Before)

Regional Affiliate Marketing Program (After)

Standards Within NextGen

Messaging Exchange Protocols Technology/Coding Systems

HL7 https CPT

ANSI ASC X12 IHE XDM First Databank

CCR IHE XDS ICD-9

CCD MLLP LOINC

CCOW SOAP 1.1 SNOMED CT

CDA UDP

ELINCS Web services

MAPI

NCPDP Script 8.1

TWAIN

XML

Vendor CCHIT Compliance

85+ EMR vendors

18 EMR vendors

(as of 2/20/08)

2008

?

NextGen Healthcare is committed to annual CCHIT certification status

• Adventist Health System

• Banner Health Systems

• Bozeman Deaconess Health

• Catholic Healthcare West

• CentraState Medical Center

• Centegra Primary Care/Horizon

• Centura Health

• Children's Hospital of Orange County

• Doylestown Hospital

• Elmhurst Memorial Healthcare

• Hackley Primary Care

• Hoag Practice Management, Inc.

• HMA - Health Management Assoc.

• Hunterdon Healthcare System

• Kittitas Valley Community Hospital

• Mercy Health Partners, Toledo, OH

• Mercy Health Partners, Lorain, OH

• Meridian Health System

• Mount Carmel Health

• Munson Healthcare

• Piedmont Medical Foundation

• Santa Clara Valley Health

• St. Croix Regional Medical (USVI)

• St. Francis Health System

• St. Michael’s Hospital

• Scottsdale Healthcare

• Stormont-Vail Healthcare

• United Health Services

• W.A. Foote Health System

Health Systems/Clinics (partial list)

8/30/2014 55

• Referrals – % completed, in network, on time with right data (one group saw average referral turnaround go from 2 weeks to 24 hours)

• Data availability at time of encounter (notifications with every encounter – reduction of chart prep FTEs, encounter time focused on care not data gathering)

• Cost reduction – chart prep, reentry, duplicate test reduction (one practice had a policy of repeating all tests)

• Length of patient stay in hospital (Cardiology group projecting many one day early discharges as a result of HIE)

• Emergency room utilization – patient safety (St Joseph’s / Trinity, getting close to critical mass – current estimate that over 50% of patients coming to ER have records in A3HIE)

• Medication reconciliation (when data first consolidated one child came in with 25 medications)

• Membership expansion (double the number of lives from one year ago, 5th “founding” member under consideration)

Ann Arbor CHS Profile

Speaker

• 25+ Years in Revenue Cycle Management & Billing Service Administration

• BA, Brigham Young University

• Author, 2 books, hundreds of articles including articles for the MGMA

Connexion and Advance For Health Information Executives

• Educator for many organizations including various MGMA chapters and Metro

managers groups.

• Certifications from IBM, 3Com, Miller-Heiman, Franklin Covey and JES.

• Longstanding active participant with MGMA & HFMA

James M Muir VP Sales NextGen Healthcare – Southwest Region NextGen Healthcare Speaker, Author, Educator www.linkedin.com/in/puremuir/ jmuir@RCMguy.com